Explore Everyday Health

Save

What Are the Facts About Treating Osteoarthritis?

I've been diagnosed with osteoarthritis in my fingers and back, and I would like to know what to do next. Are there specific diets to treat arthritis? What exactly is osteoarthritis? How is it created? Can it be reversed, completely, permanently?

Sign Up for Our Living with Chronic Pain Newsletter

Thanks for signing up!

Osteoarthritis (OA) happens in our later years, around age 50 (primary OA), and is the most common form of arthritis. Among women, osteoarthritis may start around menopause. OA may start at a younger age, due to joint injuries from sports or accidents, congenital deformities, and, rarely, metabolic problems (secondary OA).

In the hands, primary OA can affect the joints at the base of the thumbs, the end of the fingers — where bony nodules can form — and sometimes in the middle of the fingers, but it spares the wrist and knuckles. The spine at the neck and back, knees, toe joints, and hip joints may be involved — in this order of frequency.

Osteoarthritis initially causes biochemical changes in joint cartilage that affect its structural integrity and thickness. It is not clear what causes these changes, but aging alone is not the answer. Metabolic and enzymatic processes in the cells of the cartilage cause deterioration and thinning. In a few patients there is inflammation with redness, swelling, and pain, mainly in the end joints of fingers and the bases of thumbs. This is called inflammatory OA and may be confused with rheumatoid arthritis. Most patients with ordinary OA have no inflammation in the beginning, but later small pieces of cartilage may get in the joint lining (synovium) and cause inflammation.

Diagnosis of OA requires examination of all joints for pain, bony nodules, creaking, deformities, stability, excess fluid in the knees, limited motion, contractures, and muscle atrophy. It is best to have the examination done by a rheumatologist. Baseline X-rays of involved joints help assess damage, and can be compared to later ones to monitor progression. Joint fluid in an OA joint is non-inflammatory and may provide additional clues (crystals of pseudogout, for example, which is a type of arthritis that may coexist with OA).

Osteoarthritis can be treated but not reversed. The abnormal findings and the degree of pain and dysfunction will be a guide to treatment. There is no specific diet to prevent or treat any type of arthritis, except for gout where meat, game, and wine should not be consumed in excess.

What you do next depends on how painful your condition is and what you can modify to alleviate pain and improve your wellbeing. Treatment depends on the joints involved: It should focus on relieving pain, removing excessive joint stress, maintaining joint mobility, and improving muscle strength.

The first step for pain relief is acetaminophen (Tylenol), 325-500mg, one to two tablets twice per day and no more than 4g per day. The next step would be COX-2 inhibitors (celecoxib) or nonsteroidal antiinflammatory drugs (NSAIDs) like naproxen, ibuprofen, and Indomethacin. NSAIDs should be taken with food or a drug that protects your stomach (lansoprazole, omeprazole or antacids). Opioid (narcotic-type painkillers) drugs are rarely needed and should be avoided, as they can cause constipation and addiction.

Joint injections of hyaluronate (a component of normal cartilage and joint fluid) may help for up to six months. If there is inflammation, joint injection with a long-acting steroid can help for several months. Glucosamine and chondroitin sulfate supplements can help some patients with pain relief, and certain studies claim a minute improvement in cartilage thickness. A new drug, diacerein, is in clinical trials for OA. Pain can also be helped with cold or warm compresses, capsaicin cream, and other local creams or gels. Some patients find relief from acupuncture.

Relief of joint stress includes weight loss if you are overweight and avoidance of excessive exercise (e.g., running with an osteoarthritic hip or knee). There are simple exercises for maintaining joint mobility and strengthening muscle that are best taught by a physical therapist. There are also water exercise programs sponsored by the Arthritis Foundation, usually at your neighborhood YMCA. At times, reconstructive (orthopedic) surgery is needed, especially for hip and knee OA.

Resources available include explanatory pamphlets from the Arthritis Foundation and other educational materials from the American College of Rheumatology and your rheumatologist's office. You can find links to the above at Everyday Health's arthritis resource page.

This site complies with the HONcode standard for trustworthy health information: verify here.

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about
your visits to this Site and other websites in order to provide advertisements about goods and services of
interest to you. If you would like to obtain more information about these advertising practices and to make
choices about online behavioral advertising, please click here.